For individuals experiencing gluteus minimus pain and are unsure where to start to deal with it, can a physical therapist, chiropractor, or general practitioner help diagnose lower extremity pain and develop an appropriate treatment plan?
Gluteus Minimus Muscles
The gluteus minimus is the smallest muscle of the gluteal muscles. Combined with the gluteus maximus and gluteus medius, these muscles make up the glutes. The glutes help form the buttocks shape, stabilize the hips, rotate the legs, and raise the thighs. The gluteus minimus and medius specifically support the gluteus maximus’s ability to raise the leg to the side and rotate the thigh inwards. (ScienceDirect. 2011)
Anatomy
The gluteus minimus muscles are triangular and lie underneath the gluteus medius near the rotators of the hip joints. The muscles start in the lower ilium region, the upper and largest area of the hip bone that makes up the pelvis and attaches to the femur/thigh bone.
The fibers on the top part of the muscle are thick and compact, while the lower fibers are flat and spread out.
The superior gluteal nerves and blood vessels separate the gluteus minimus and the medius.
The gluteus medius muscles start on the upper ilium region, which covers the gluteus minimus muscle entirely. The location of the gluteus minimus muscles envelopes the sciatic notch or the area in the pelvis that houses the piriformis muscle, superior gluteal vein, and superior gluteal artery, which provide a certain amount of protection.
Function
Movement depends on the location of the femur. The gluteus minimus muscle’s function is to:
Flex
Rotate
Stabilize
When the thigh is extended, it helps abduct or swing the leg out away from the body.
When the hip bones are flexed, the gluteus minimus rotates the thigh inward with the help of the gluteus medius.
The movements are done with the support of the muscle fibers, which contract to move the thigh in both directions. (ScienceDirect. 2011)
The gluteus minimus and the medius also stabilize the hips and pelvis during movement and when resting.
Associated Conditions
One of the most common injuries is muscle wearing and tearing, which can cause pain over and around the greater trochanter. This is known as greater trochanteric pain syndrome or GTPS, a condition usually caused by a gluteus medius or minimus tendinopathy, which can include inflammation of the surrounding bursae. (Diane Reid. 2016) For a gluteus minimus tear, the pain/sensations will be felt outside the hip, especially when rolling or applying weight on the affected side. A tear can happen suddenly with no particular activity causing the tear to occur aside from normal use and stress on the muscle. Physical activities like walking may be painful.
Rehabilitation
Treatment depends on the severity of the condition. Usually, rest, ice, and over-the-counter medication can help reduce swelling and pain symptoms. For pain symptoms that are not subsiding, it’s recommended to see a healthcare provider who can run an MRI or X-ray to see the condition of the muscle and rule out other causes of pain. The healthcare provider will refer the patient to a physical therapy team that can evaluate the strength of the gluteus minimus and provide a list of exercises and stretches to help repair the muscle while conditioning the surrounding muscles. (SportsRec. 2017) Depending on the level of pain, sometimes the healthcare provider will prescribe a cortisone injection to the gluteus minimus muscle in conjunction with physical therapy. This will help alleviate the pain so that the physical therapy exercises can be done comfortably, allowing the gluteus maximus muscle to heal properly and strengthen. (Julie M. Labrosse et al., 2010)
Reid D. (2016). The management of greater trochanteric pain syndrome: A systematic literature review. Journal of orthopaedics, 13(1), 15–28. doi.org/10.1016/j.jor.2015.12.006
Labrosse, J. M., Cardinal, E., Leduc, B. E., Duranceau, J., Rémillard, J., Bureau, N. J., Belblidia, A., & Brassard, P. (2010). Effectiveness of ultrasound-guided corticosteroid injection for the treatment of gluteus medius tendinopathy. AJR. American journal of roentgenology, 194(1), 202–206. doi.org/10.2214/AJR.08.1215
For individuals trying to build muscle but are not seeing results, can knowing factors like what foods to eat, how to work out, and genetics help achieve meaningful muscle gains?
Muscle Growth Nutritional Mistakes
Muscle growth is an important element of overall fitness and health. Individuals can make nutritional mistakes like not eating enough protein or carbohydrates and not properly hydrating themselves which can prevent them from gaining muscle. Factors that contribute to muscle building, include:
Nutrition
Genetics
Training
Individuals who want to increase muscle mass more efficiently can rework these issues to maintain consistency and commitment to exercise and nutrition. Benefits include:
Building muscle helps strengthen bones
Improves balance
Decreases the risk of cardiovascular disease and diabetes.
Experts point out some common mistakes that can hinder muscle growth, like not eating enough protein, not consuming enough calories, overtraining, or practicing improper form and technique. As everybody is different there is no one-size-fits-all approach to building muscle or hypertrophy. These include:
Genetics
An individual’s genes contribute to how easy or difficult it can be to build muscle.
Some individuals have a higher proportion of fast-twitch muscle fibers, which increases growth potential.
The natural distribution of muscle and body fat also varies and can affect the rate and location of muscle growth.
There are also differences in individual recovery capabilities that can influence the frequency and intensity of training sessions.
Nutrition
Nutrition matters when trying to build muscle. Individuals need to eat enough protein for muscle repair and growth.
Individuals may need to consume more calories than they burn to create energy stores.
At the same time, individuals need to consume enough carbohydrates and healthy fats to fuel workouts and recovery.
Training
Gaining muscle requires regular resistance or strength training exercises.
These exercises cause micro tears in muscle fibers, which then repair and grow back stronger and larger.
Effective resistance training includes – consistency, intensity, recovery, and progressive overload.
Progressive overload means gradually increasing the weight, frequency, or number of repetitions in an exercise routine to challenge the muscles.
Muscle Strength for Healthy Aging
Research shows that performing exercises that build muscle mass can slow age-related cognitive decline and decrease the risk of neurodegenerative diseases like Alzheimer’s disease and dementia. (Joseph Michael Northey, et al., 2018)
Muscle-building exercise can also improve heart health and lower the risk of cardiovascular diseases. (Johns Hopkins Medicine. 2023)
Nutritional Mistakes
When trying to gain muscle, challenges can affect progress. Some of the most common mistakes that can delay or set back muscle growth and recommendations include.
Not Enough Protein
Eating protein like lean meats, dairy products, and seafood, is crucial for muscle repair and growth.
Not consuming enough protein makes the body unable to grow muscles, and you’ll see suboptimal improvements.
Get enough protein from various sources like beef, lamb, chicken, turkey, fish, eggs, dairy, legumes, and plant-based proteins.
However, there is a limit to how much protein the body can use effectively at one time for muscle protein synthesis.
It is recommended to distribute protein intake evenly throughout the day, aiming for about 20 to 30 grams of high-quality protein in each meal.
If the body is in a caloric deficit, the ability to grow muscle is limited.
Insufficient calorie intake can create energy deficits, making the body use muscle for energy instead of growing.
To fix this, individuals need to consume more calories than calories burned.
It can be helpful to track calorie intake with an application to make adjustments as needed.
Individuals having trouble increasing their calorie intake or there are questions about what the body needs, consult with a registered dietitian or nutritionist.
Not Enough Carbs
Carbohydrates are the body’s main energy source during high-intensity workouts.
Not consuming enough can lead to decreased performance and slower recovery.
Recommendations include consuming a variety of whole grains and minimally processed carbohydrates, such as brown rice, potatoes, sweet potatoes, oats, and quinoa.
For individuals doing regular, moderate-to-intense training, carbohydrate recommendations can range from 3 to 7 grams per kilogram of body weight per day.
For individuals doing endurance or intense frequency training routines may need to increase this range.
Not Hydrating Enough
Water is necessary for all bodily functions, including muscle contraction and repair.
For individuals who are not sure how much water they need? Recommendations include using half of an individual’s body weight as a starting point to figure out how many ounces to drink per day.
For example, individuals who weigh 140 pounds can set a baseline hydration goal of 70 ounces of water/8 cups per day which can be adjusted according to activities.
Water Intake Recommendations
The recommended total fluid intake from food and drink varies by age and sex. The general recommendations are around:
11.5 cups per day for women
15.5 cups for adult men
For just water, women need around 9 cups of fluid per day, and men need around 13 cups to replace fluids that are lost throughout the day.
However, the exact amount of water needed to stay properly hydrated also depends on an individual’s activity level and overall health. (Academy of Nutrition and Dietetics. 2022)
To prevent dehydration, sip water consistently throughout the day, especially before, during, and after workouts.
Foods with a high water content like certain fruits can help achieve daily hydration goals.
Not Enough Healthy Fats
Not consuming enough healthy fats can cause the body to not be able to produce enough hormones that support muscle growth.
Relying on supplements instead of getting nutrients from whole foods can also lead to nutritional deficiencies and imbalances.
Recommendations are to add more healthy fats, like avocados, nuts, seeds, fatty fish, and olive oil.
Forgetting Post-Workout Nutrition
After working out, the body is ready to absorb nutrients and start the process of muscle repair and growth.
The body needs nutrients to activate the recovery post-exercise
When the body lacks nutrition after a workout it can slow muscle growth and cause fatigue.
Recommendations are to pack a balance of protein and carbohydrates to refuel right after a workout.
Training Mistakes
Undertraining or performing low-intensity workouts can also slow down muscle growth.
Individuals who are not overloading their muscles – for example, using weights that are too light – will not break them down so they can grow bigger and stronger.
A lack of microdamage means muscle growth will be slower.
Muscle overload also requires rest.
Recommendations are to take at least one day of rest per week and avoid strength training in the same muscle group two days in a row.
When creating a lifting plan, be sure to include compound exercises like squats, deadlifts, and bench presses.
These exercises work with multiple muscle groups and are recommended for building strength and muscle.
A training routine should include a variety of compound movements, like lunges, split squats, leg presses, pull-downs, upright rows, and push-ups.
If unsure of which compound exercises to include, consult a personal trainer, physical therapist, or sports chiropractor.
Northey, J. M., Cherbuin, N., Pumpa, K. L., Smee, D. J., & Rattray, B. (2018). Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. British journal of sports medicine, 52(3), 154–160. doi.org/10.1136/bjsports-2016-096587
When a groin strain injury happens, can knowing the symptoms help in the diagnosis, treatment, and recovery times?
Groin Strain Injury
A groin strain is an injury to an inner thigh muscle. A groin pull is a type of muscle strain affecting the adductor muscle group (the muscles help pull the legs apart). (Parisa Sedaghati, et al., 2013) The injury is caused when the muscle is stretched beyond its normal range of motion, creating superficial tears. Severe strains can tear the muscle in two. (Parisa Sedaghati, et al., 2013)
A groin muscle pull causes pain and tenderness that worsens when squeezing the legs together.
There may also be swelling or bruising in the groin or inner thigh.
An uncomplicated groin pull takes four to six weeks to heal with proper treatment. (Andreas Serner, et al., 2020)
Symptoms
A groin pull can be painful, interfering with walking, navigating stairs, and/or driving a car. In addition to pain, other symptoms around the injured area include: (Parisa Sedaghati et al., 2013)
A popping sound or snapping sensation when the injury occurs.
Increased pain when pulling the legs together.
Redness
Swelling
Bruising of the groin or inner thigh.
Groin pulls are graded by severity and how much they impact mobility:
Grade 1
Mild discomfort but not enough to limit activities.
Grade 2
Moderate discomfort with swelling or bruising that limits running and/or jumping.
Grade 3
Severe injury with significant swelling and bruising can cause pain while walking and muscle spasms.
Signs of a severe groin strain
Difficulty walking
Groin pain while sitting or resting
Groin pain at night
A healthcare provider should see severe groin pulls because the muscle may have ruptured or be on the verge of rupturing.
In severe cases, surgery is necessary to reattach the torn ends.
Groin pulls are sometimes accompanied by a stress fracture of the pubis/forward-facing pelvic bones, which can significantly extend healing and recovery time. (Parisa Sedaghati et al., 2013)
Causes
Groin pulls are often experienced by athletes and individuals who play sports where they must stop and change directions quickly, placing excessive strain on the adductor muscles. (Parisa Sedaghati et al., 2013) The risk is increased in individuals who: (T. Sean Lynch et al., 2017)
Have weak hip abductor muscles.
Are not in adequate physical condition.
Have a previous groin or hip injury.
Pulls can also occur from falls or extreme activities without the proper conditioning.
Diagnosis
A healthcare provider will perform a thorough investigation to confirm the diagnosis and characterize the severity. This involves: (Juan C. Suarez et al., 2013)
Medical History Review
This includes any previous injuries and specifics about where and when the symptoms started.
Physical Examination
This involves palpating – lightly touching and pressing the groin region and manipulating the leg to understand better where and how extensive the injury is.
Imaging Studies
Ultrasound or X-rays.
If a muscle rupture or fracture is suspected, an MRI scan may be ordered to visualize soft tissue injuries and stress fractures better.
Differential Diagnosis
Certain conditions can mimic a groin pull and require different treatments. These include: (Juan C. Suarez, et al., 2013)
Sports Hernia
This type of inguinal hernia occurs with sports and work injuries.
It causes a portion of the intestine to pop through a weakened muscle in the groin.
Hip Labral Tear
This is a tear in the cartilage ring of the labrum outside the rim of the hip joint socket.
Hip Osteoarthritis
This is the wear-and-tear form of arthritis that can present with groin pain symptoms.
Osteitis Pubis
This is inflammation of the pubic joint and surrounding structures, usually caused by the overuse of the hip and leg muscles.
Referred Groin Pain
This nerve pain originates in the lower back, often due to a pinched nerve, but is felt in the groin.
Treatment
Beginning treatment is conservative and includes rest, ice application, physical therapy, and prescribed gentle stretching and exercises.
Individuals may need crutches or a walking device to reduce pain and prevent further injury if the pain is significant. (Andreas Serner, et al., 2020)
Physical therapy will be a part of the treatment plan.
Over-the-counter pain medications like Tylenol/acetaminophen or Advil/ibuprofen can help with pain relief short term.
If there is severe pain from a grade 3 injury, prescription medications may be used for a short period to help minimize pain. (Andreas Serner, et al., 2020)
Sedaghati, P., Alizadeh, M. H., Shirzad, E., & Ardjmand, A. (2013). Review of sport-induced groin injuries. Trauma monthly, 18(3), 107–112. doi.org/10.5812/traumamon.12666
Serner, A., Weir, A., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., & Hölmich, P. (2020). Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic journal of sports medicine, 8(1), 2325967119897247. doi.org/10.1177/2325967119897247
Lynch, T. S., Bedi, A., & Larson, C. M. (2017). Athletic Hip Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 25(4), 269–279. doi.org/10.5435/JAAOS-D-16-00171
Suarez, J. C., Ely, E. E., Mutnal, A. B., Figueroa, N. M., Klika, A. K., Patel, P. D., & Barsoum, W. K. (2013). Comprehensive approach to the evaluation of groin pain. The Journal of the American Academy of Orthopaedic Surgeons, 21(9), 558–570. doi.org/10.5435/JAAOS-21-09-558
Individuals suffering from hip, thigh, and/or groin pain could be experiencing iliopsoas syndrome. Could knowing the symptoms and causes help in diagnosis and treatment?
Iliopsoas Syndrome
Iliopsoas syndrome encompasses several conditions that affect the inner hip muscle and can cause hip and thigh pain. The muscle helps to bend the leg toward the body.
The condition is usually caused by overuse injuries and commonly affects individuals who perform repeated hip flexion movements, like cyclists, gymnasts, dancers, runners, and soccer players. (Liran Lifshitz, et al., 2020)
The term is often used interchangeably with psoas syndrome, iliopsoas tendonitis, snapping hip syndrome, and iliopsoas bursitis. However, there are clinical differences.
Hip or groin clicking or snapping that can be heard and/or felt during movement.
Pain and/or stiffness in the hip and thigh area.
Pain that worsens when bending the hip – walking, climbing stairs, squatting, sitting.
Movements that involve bringing the knee toward the chest can worsen the pain.
Causes
The iliopsoas muscles are hip muscles on the front of the hip. They are made up of the psoas major, the psoas minor, and the iliacus. Small, fluid-filled sacs/bursae are within the hip joint between bones and soft tissues. The bursae reduce friction and provide cushioning to help the tendons, muscles, and other structures move smoothly over the bony prominences.
Iliopsoas bursitis happens when the bursa, which is located between the iliopsoas tendon and the inside of the hip joint, becomes inflamed and irritated.
Iliopsoas tendonitis/hip tendonitis happens when the tendon that attaches the thigh bone to the iliopsoas muscle becomes inflamed and irritated.
Iliopsoas bursitis and tendonitis are commonly caused by overuse injuries and intense activities like cycling, running, rowing, or strength training.
Diagnosis
Healthcare providers can diagnose iliopsoas syndrome based on symptom history and a hip examination.
Imaging tests – MRI and X-rays may be used to rule out other injuries or conditions like muscle tears. (Paul Walker, et al., 2021)
Avoid putting weight on the hip for a few days after the injury.
Ice
Apply ice immediately after the injury to bring the swelling down.
Use a cold pack for 20 minutes at a time, several times a day.
Do not apply ice directly on the skin.
Compression
Wrap the area in a soft bandage or use compression shorts to prevent further swelling.
Elevation
Rest as often as possible with the leg raised higher than the heart.
Medical Treatment
Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen sodium can alleviate pain and reduce inflammation. (Paul Walker, et al., 2021)
Steroid injections can be used if symptoms continue or come back with additional injections administered as necessary. (Paul Walker, et al., 2021)
After pain and swelling subside, physical therapy may be recommended, as well as mild exercises to gradually improve hip strength and flexibility. (Paul Walker, et al., 2021)
A healthcare provider may recommend surgery in severe cases where pain persists, and conservative treatments don’t provide enough relief.
Lifshitz, L., Bar Sela, S., Gal, N., Martin, R., & Fleitman Klar, M. (2020). Iliopsoas the Hidden Muscle: Anatomy, Diagnosis, and Treatment. Current sports medicine reports, 19(6), 235–243. doi.org/10.1249/JSR.0000000000000723
Walker, P., Ellis, E., Scofield, J., Kongchum, T., Sherman, W. F., & Kaye, A. D. (2021). Snapping Hip Syndrome: A Comprehensive Update. Orthopedic reviews, 13(2), 25088. doi.org/10.52965/001c.25088
American Association of Orthopedic Surgeons. OrthoInfo. Hip strains.
Can various therapeutic options provide relief for individuals with upper crossed syndrome to restore muscle strength?
Introduction
Many individuals often suffer neck and shoulder pain from poor posture, improper heavy lifting, musculoskeletal conditions, auto accidents, whiplash, etc. The surrounding muscles that connect the neck and shoulders help protect the cervical and thoracic region of the spine and can succumb to injuries that can cause pain-like symptoms causing discomfort to the individual. Neck, shoulder, and back pain are the three most common issues many individuals have experienced. These musculoskeletal disorders can also correlate with pre-existing conditions; many people will feel pain and discomfort while trying to find the relief they seek. One of the most common issues people often experience is upper crossed syndrome, which can be associated with neck and shoulder pain. Today’s article explains what upper cross syndrome is and how it affects the neck and shoulders while also diving into how different therapeutic options like spinal decompression and chiropractic care can reduce the effects of upper cross syndrome. We speak with certified medical providers who incorporate our patients’ information to provide numerous treatment plans to mitigate upper-crossed syndrome in the neck and shoulders. We also inform our patients that there are many therapeutic options, like chiropractic care and spinal decompression, to minimize muscle pain in the neck and shoulders. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with upper-crossed syndrome. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer
What Is Upper Crossed Syndrome?
Have you been dealing with muscle pain in your shoulders or neck after being on the computer for a while? Do you feel stiffness in your shoulders that rotating them causes temporary relief? Or does it hurt when you turn your head from side to side? Many of these pain-like scenarios are often associated with upper-cross syndrome. Many people don’t often realize that upper crossed syndrome is a musculoskeletal condition that affects the neck, shoulder, and chest muscles and causes them to be weak and tight due to poor posture. The upper crossed syndrome can cause referred pain to the upper extremities, leading to cervicogenic headaches, limited range of motion, trigger points in the muscles, and muscle imbalance. (Moore, 2004) When many people are dealing with upper crossed syndrome due to poor posture, it can lead to many issues in the neck and shoulders.
How Does It Affect The Neck & Shoulders?
Now, why does upper crossed syndrome affect the neck and shoulders? Many people unintentionally hunched over when looking at their phones, being on the computer, or relaxing at home. This causes specific muscles in the neck and shoulder region, like the serratus and lower trapezius muscles, to become weak while the pectoral and neck muscles are tight. (Chu & Butler, 2021) This, in turn, causes the shoulders to be more rounded and hunched, causing the neck and head to crane forward. When people are dealing with upper crossed syndrome, many would often complain about pain-like symptoms like:
Headaches
Neck Strain
Muscle tightness
Upper back pain
Restricted range of motion
Numbness/Tingling sensations in the arms
The upper crossed syndrome can also occur gradually over time and cause nerve compression to the upper extremities. When the upper neck and shoulder muscles start to affect the surrounding nerve roots, which then leads to nerve dysfunction in the sensory and motor skills when a person picks up an object. (Lee & Lim, 2019) However, many individuals dealing with upper-crossed syndrome can seek treatment to relieve muscle pain in their neck and shoulders.
An Overview Of Upper Crossed Syndrome- Video
Since upper cross syndrome is a musculoskeletal condition that affects the neck and shoulders, it can result in muscle imbalance and pain in the individual. Many people, especially in the working field, develop this syndrome by being hunched over for an extended period. (Mujawar & Sagar, 2019) This causes the head to be more forward, the neck posture to be curved and hunched, and the shoulders to be rounded. The video above explains upper-crossing syndrome, its causes, and how it is treated.
Numerous treatments can help restore muscle strength and reduce muscle pain in the neck and shoulders. Treatments like spinal decompression can help reduce upper crossed syndrome by slowly using gentle traction to the cervical spine region and gently stretching the neck muscles to provide relief. Spinal decompression is one of the non-surgical treatments that many individuals with headaches associated with upper crossed syndrome can find the comfort they seek through pain reduction and improve their quality of life. (Eskilsson et al., 2021) At the same time, spinal decompression can be part of a personalized treatment plan that many individuals can add to their daily routine to prevent the pain from returning. (Saunders, 1983)
Chiropractic Care Restoring Muscle Strength
Just like spinal decompression, chiropractic care is a non-surgical treatment that can be combined with various stretching techniques to restore the neck’s range of motion and reduce pain associated with upper-crossed syndrome. (Mahmood et al., 2021) Chiropractic care incorporates manual and mechanical techniques like MET (muscle energy techniques) and spinal manipulation to realign the spine out of subluxation. When chiropractors integrate MET to manage upper crossed syndrome, many individuals find that their pain has decreased, their cervical range of motion is improved, and their neck disability is reduced. (Gillani et al., 2020) When many individuals start thinking about their health and wellness, they can make small changes to improve their posture and be more mindful of their bodies to reduce the chances of upper-cross syndrome returning.
References
Chu, E. C., & Butler, K. R. (2021). Resolution of Gastroesophageal Reflux Disease Following Correction for Upper Cross Syndrome-A Case Study and Brief Review. Clin Pract, 11(2), 322-326. doi.org/10.3390/clinpract11020045
Eskilsson, A., Ageberg, E., Ericson, H., Marklund, N., & Anderberg, L. (2021). Decompression of the greater occipital nerve improves outcome in patients with chronic headache and neck pain – a retrospective cohort study. Acta Neurochir (Wien), 163(9), 2425-2433. doi.org/10.1007/s00701-021-04913-0
Gillani, S. N., Ain, Q., Rehman, S. U., & Masood, T. (2020). Effects of eccentric muscle energy technique versus static stretching exercises in the management of cervical dysfunction in upper cross syndrome: a randomized control trial. J Pak Med Assoc, 70(3), 394-398. doi.org/10.5455/JPMA.300417
Lee, E. Y., & Lim, A. Y. T. (2019). Nerve Compression in the Upper Limb. Clin Plast Surg, 46(3), 285-293. doi.org/10.1016/j.cps.2019.03.001
Mahmood, T., Afzal, W., Ahmad, U., Arif, M. A., & Ahmad, A. (2021). Comparative effectiveness of routine physical therapy with and without instrument assisted soft tissue mobilization in patients with neck pain due to upper crossed syndrome. J Pak Med Assoc, 71(10), 2304-2308. doi.org/10.47391/JPMA.03-415
Moore, M. K. (2004). Upper crossed syndrome and its relationship to cervicogenic headache. J Manipulative Physiol Ther, 27(6), 414-420. doi.org/10.1016/j.jmpt.2004.05.007
Mujawar, J. C., & Sagar, J. H. (2019). Prevalence of Upper Cross Syndrome in Laundry Workers. Indian J Occup Environ Med, 23(1), 54-56. doi.org/10.4103/ijoem.IJOEM_169_18
Saunders, H. D. (1983). Use of spinal traction in the treatment of neck and back conditions. Clin Orthop Relat Res(179), 31-38. www.ncbi.nlm.nih.gov/pubmed/6617030
Hamstring muscle injuries are common, especially in athletes and individuals with physically demanding jobs. Is there a better chance of full recovery with surgical repair and post-op rehabilitation?
Hamstring Muscle Tear
Most often, hamstring muscle injuries are partial tears of the muscle. These types of injuries are muscle strains that occur when the muscle fibers are stretched beyond their normal limits. Complete tears of the hamstring muscle are unusual, but they do occur in both athletes and non-athletes. Determining the optimal treatment plan depends on:
The severity of the tendon tear
The expectations of the injured individual.
Incomplete tears are when the hamstring muscle is stretched too far, but not completely detached.
Complete tears usually occur at the top of the muscle where the tendon tears away from the pelvis.
A complete tear usually occurs when there is a sudden flexion of the hip and extension of the knee joint – when the muscle contracts in this position, it gets stretched beyond its limits.
Basic hamstring strains can be treated with simple steps – rest, ice, anti-inflammatory medications, and conservative therapies.
Symptoms
Symptoms of a hamstring muscle strain can include pain, bruising, swelling, and movement difficulty. (American Academy of Orthopaedic Surgeons. 2021) Individuals who sustain this injury typically experience sudden sharp pain. Signs of a tear can include:
Sharp pain where the buttock and thigh meet.
Difficulty walking.
Sitting can be difficult as the edge of a chair can place pressure directly on the injury.
Spasms and cramping sensations in the back of the thigh.
Weakness in the leg, specifically when bending the knee or lifting the leg behind the body.
Numbness or burning sensations as a result of sciatic nerve irritation.
Swelling and bruising in the back of the thigh – over time it can travel down to the back of the knee and calf and possibly into the foot.
With a complete hamstring tear, there is usually significant swelling and bruising that develops in the back of the thigh.
Diagnosis
The symptoms can be difficult to spot in the early stages which is why X-rays of the hip or thigh are usually obtained.
In some situations, a fragment of bone can get pulled off the pelvis along with the hamstring muscle attachment. MRI testing can be performed to evaluate the attachment and can define critical features of a complete hamstring muscle tear, including: (American Academy of Orthopaedic Surgeons. 2021)
The number of tendons involved.
Complete versus incomplete tearing.
The amount of retraction – the amount the tendons have pulled back.
This will guide the development of treatment.
Treatment
The treatment of a complete tear will depend on different factors. The other variable is the patient and their expectations.
Treatment is more aggressive in younger individuals like high-level athletes.
Treatment is less aggressive in middle-aged individuals.
Often a single tendon tear can be treated non-surgically.
When one tendon is involved, it is typically not pulled very far from its normal attachment and will develop scar tissue in a positive position.
Conversely, when three tendons have been torn, they usually pull more than a few centimeters away from the bone. These cases have better results with surgical repair. (UW Health. 2017)
Surgeons will use patient characteristics – high-level athletes or less physically active individuals – to guide treatment recommendations.
Rehabilitation
Rehabilitation following surgery can take 3-6 months or longer.
The first six weeks limit weight-bearing with the use of crutches.
Patients may be recommended to wear a brace to reduce tension on the repaired hamstring tendons.
Strengthening does not begin until three months post-op, and even light activities are usually delayed. (UW Health. 2017)
Because this injury can have a long recovery time, some individuals may choose nonsurgical treatment.
Sometimes these individuals experience symptoms of discomfort from sitting and may exhibit long-term weakness of the hamstring muscle.
Full recovery from a complete hamstring muscle injury takes time. Studies have shown high-level athletes are able to resume competitive sports after the repair and rehabilitation of an acute hamstring muscle injury. (Samuel K. Chu, Monica E. Rho. 2016)
Delaying surgical treatment may not always lead to optimal results.
When the tendon is torn away from its normal attachment, it begins to scar around the surrounding soft tissues.
When there is a delay of more than a few weeks following the initial injury, regaining the full length of the tendon and muscle can be challenging.
This could delay the rehabilitation process and may limit the potential for full recovery. (Ho Yoon Kwak, et al., 2011)
With severe injuries, there is a better chance of full recovery with surgical repair but could involve a long recovery and commitment to a post-op rehabilitation plan.
Chu, S. K., & Rho, M. E. (2016). Hamstring Injuries in the Athlete: Diagnosis, Treatment, and Return to Play. Current sports medicine reports, 15(3), 184–190. doi.org/10.1249/JSR.0000000000000264
Kwak, H. Y., Bae, S. W., Choi, Y. S., & Jang, M. S. (2011). Early surgical repair of acute complete rupture of the proximal hamstring tendons. Clinics in orthopedic surgery, 3(3), 249–253. doi.org/10.4055/cios.2011.3.3.249
When individuals experience a neuromusculoskeletal injury strain, can following basic pulled muscle treatment protocols help in healing and a full recovery?
Pulled Muscle Treatment
A pulled muscle or muscle strain occurs when a muscle is stretched beyond its ability resulting in discomfort symptoms and mobility issues. Microscopic tears can occur within the muscle fibers potentially worsening the injury. This type of injury usually causes mild to severe pain, bruising, and immobility, and nerve injuries can develop as well. Common muscle strains include:
Pulled hamstrings
Groin strains
Pulled abdominal muscles
Calf strains
Pulled muscle treatment requires patience to promote proper healing and restoration of optimal function.
Individuals need to focus on the different stages of healing.
Gradually increase activity levels as the body allows to prevent stiffness and atrophy which can cause complications.
Symptoms
The usual symptoms of this type of injury include:
Pain
Limited mobility
Muscle spasms
Swelling
Bruising
Often individuals will feel a sudden grabbing or tearing sensation and are then unable to continue the activity.
Can limit the ability to perform certain activities.
May have moderate swelling and bruising.
Grade III
Severe injury that can cause significant pain.
Muscle spasms.
Swelling.
Significant bruising.
Basic Treatment Protocols
Most pulled muscle strain injuries heal with simple treatment. Following the right steps can ensure an expedited recovery. In the early stages after the injury, there is a balance between doing too much or not enough. The amount of activity an individual will be able to do, and the time required for recovery depends on the severity of the injury. Here are some guidelines in the right direction.
Rest
Rest is recommended for the early recovery stage.
Depending on the severity of the injury this could last from one to five days.
Immobilization is usually not necessary, and not moving at all can lead to muscle and joint stiffness.
To avoid injuries make sure the muscles are not over-exerted.
Gradually increase activity levels when starting an exercise program to build endurance.
Properly Warming Up
Warming up before taking on physical activities will help loosen the muscles and prevent injuries.
Beginning work or exercise with stiff muscles can lead to an increased chance of strain.
Studies have shown that temperature can influence the stiffness of a muscle. (K. W. Ranatunga. 2018)
Maintaining body and muscle warmth helps prevent injury and re-injury.
Injuries and Chiropractic: The Road To Recovery
References
Hospital for Special Surgery, Muscle Strain: What You Need to Know About Pulled Muscles.
Kary J. M. (2010). Diagnosis and management of quadriceps strains and contusions. Current reviews in musculoskeletal medicine, 3(1-4), 26–31. doi.org/10.1007/s12178-010-9064-5
Malanga, G. A., Yan, N., & Stark, J. (2015). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate medicine, 127(1), 57–65. doi.org/10.1080/00325481.2015.992719
Mair, S. D., Seaber, A. V., Glisson, R. R., & Garrett, W. E., Jr (1996). The role of fatigue in susceptibility to acute muscle strain injury. The American journal of sports medicine, 24(2), 137–143. doi.org/10.1177/036354659602400203
Ranatunga K. W. (2018). Temperature Effects on Force and Actin⁻Myosin Interaction in Muscle: A Look Back on Some Experimental Findings. International journal of molecular sciences, 19(5), 1538. doi.org/10.3390/ijms19051538
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